Thursday, August 9, 2012

Nature, Nurture, and Hormonal Transition

We
are all constantly flowing with a complex mix of hormones. They
cycle like tides, they interrelate in fascinating ways, and they are
always shifting in response to our physical and social environments.
Among these are the “sex steroids,” such as estrogen,
progesterone, and testosterone. All of us, whatever our sex,
normally produce both the “female” and “male” sex hormones—in
fact, calling them “male” or “female” is very odd,
considering that a man requires estrogen to produce viable sperm, and
a female relies on testosterone for healthy muscle tone. It is the
relative balance of estrogen and testosterone—not the absence of
one or the other—that determines our secondary sex characteristics,
such as the development of breast tissue or facial hair. This
balance varies from person to person, because all sex characteristics
exist on a spectrum (with some of us living in the middle intersex
territory).

We
like to tell a simple story in which people have a biological sex,
over which is laid social gender (such as the clothing we wear, what
we do with the hair on our heads and bodies, or what careers our society deems appropriate for us). Our physical makeup is presented as asocial and unchanging.
In fact, we are naturally social beings, born to have our biological
makeup affected by our social experiences. For example, humans are
born with a capacity for language, but what language we learn depends
on the society into which we are born. And the language we learn, in
time, affects our brains. Depending on what phonemes are used in the
language(s) we learn as children, we become capable of distinguishing
some sounds and not others. If we learn a language in which
compass-point direction is incorporated when referring to objects, we
develop a much stronger innate sense of direction. If we learn to
communicate in sign language, the centers of our brain recruited to
produce communication develop quite differently. The brain is a
“plastic” organ, shaped by social experience.

In
my last post I critiqued the argument that having a trans identity
should be understood as an intersex disorder of the brain,
necessitating genital sex reassignment. I critiqued this argument
because (1) I'm intersex and abhor the argument that it is
“necessary” to surgically alter our genitals, and (2) the
experience of the intersex community cautions that if there were
indeed a medical test for some morphology deemed to represent a
"trans brain," the result would be eugenic abortion. I got
a lot of negative feedback on that post. Interestingly, some people
thought it implied an argument against medical transition, which it
is most assuredly not my intent (I've transitioned hormonally). My
argument was only with the idea that the way to win civil rights is to
champion a biological etiology for trans identity. As for etiologies
of gender identity or sexual orientation, my take is that I'm sure
they're incredibly complex, but also that they are as irrelevant as
the etiology of identifying as a "cat person" versus a "dog person," or, less flippantly, the
etiology of identifying with a particular religion. Many people
affiliate with the religion (or lack thereof) their parents expect
them too, but some do not, and either way, their religious identities
should be respected, without needing to look for a biological etiology of
religious preference to justify respect.

In
any case, in this post I'd like to discuss the interrelationship of
biology and social factors in hormonal transition.

In
my own life, I've lived under four different hormone balances.
First, I had the standard prepubertal hormonal milieu of low sex
steroids. At puberty, my gonads kicked in and I developed secondary
sexual characteristics—and because I had three gonads (two ovaries
and an ovotestis), I developed a lot of them. In later adulthood, my
internal reproductive organs were removed, and my sex steroid levels
soon fell to almost nil (with less testosterone, estrogen or
progesterone than what would be expected for a 90-year-old menopausal
woman). And several years later I began hormone replacement therapy
with testosterone, or “T,” leading to my living with typical male
levels of T, unaccompanied by the usual male levels of estrogen or
progesterone. I duly note that none of the three hormonal balances I
have lived under as an adult are typical ones. What I can report on
is what I experienced with a high, estrogen-dominant hormone load,
what it's like to live with no sex steroids, and what changed when I
went from no sex steroids to T alone.

There
is no doubt that hormone replacement therapy has biological effects.
When a person takes estrogen, “E,” (sometimes accompanied by
progesterone, “P”) to gender transition, she develops breasts,
deposits fat around the hips, and develops softer skin and ligaments.
When a person undergoes HRT with T to transition, his voice changes,
his phalloclitoris enlarges, and he grows more facial and body hair.
But we often talk about other changes. In the contemporary U.S., we
think of men as aggressive and dominant, and women as empathetic and
emotionally labile, and we expect these conditions will develop with
HRT. Often, friends and family worry that a trans man will become
violent if he undergoes hormonal transition, or that a trans woman
will become irrational. It's as if people see testosterone as the
Hormone of War, and estrogen as the Hormone of Overwhelming Emotion
(helpfully pictured in my little graphic above). In fact, the
effects they produce are much less drastic.

Changes
that follow HRT are real. But this does not mean that they are only
biological, not social. Consider something simple, like voice. A
few months after starting HRT, my voice changed. I was very happy
about this, as I was never comfortable with my voice. Clearly, T
precipitated changes in my vocal cords and larynx. But a lot of the
changes in my voice over the course of my transition have been
socially produced. First, there's the fact that I consciously chose
to “work” at my voice so that I spoke out of a lower part of my
register. It's extremely likely that this has affected my physical
vocal apparatus, just as a singer's vocal cords are affected by voice
training. But many of the changes in my speaking voice were not
conscious, while hardly being biological. They emerged from my being
perceived as a guy, without my much noticing what was happening.

Consider
this: have you ever noticed that you can often guess the gender of
the person a guy is speaking to on the phone by how he is talking?
Men in the U.S. today tend to speak with a higher pitch and
to articulate more clearly when speaking to women, while speaking in a
more mumbled, lower range to other guys. “Hi, Mia. Oh, sure, I
can meet you at 4 instead. See you then!” vs. “Hey, bro.
Uh-huh. Yeah, well. See ya.” So I found myself on the receiving
end of bro-talk, and as a result, the way I speak changed. My spouse
teases me about my grunted, blasé “uh-huhs.” Social
interactions changed the way my voice sounds. You can't tease out
the physical sex and social gender effects, because they interact to
produce my voice, but they are both there, each influencing the
other. And both components are equally “real.”

So:
even the embodied changes during HRT that seem physical and simple
are both biological and social. The social effects on the more social
aspects of our masculinity/femininity are almost certainly more
pronounced. Let's consider the idea that men are more aggressive, that this must be biologially caused by T, and thus that HRT with T will make a person more
dominant and violent. This belief is shaped by two things: first, by a
cultural ideology shared by all patriarchal societies that men's
dominance of society is natural, and secondly, by media reports on the phenomenon
of “roid rage” in cis men who use T illegally to build muscle
mass for sport or body building.

Let
me talk about “roid rage” first. This occurs in people who abuse
T because they take it in large and irregular doses, causing big
hormone spikes. And hormone swings do make people irritable. This
is seen, for example, in cis women who experience premenstrual mood
swings, because the level of P rises, then falls abruptly before the
menstrual period. I can report from my own experience that swings in
P level made me much more irritable than changes in T level. Note, however,
that we call a woman who is hormonally irritable “bitchy” rather
than “raging,” and see her as less threatening. . . In any case,
my experience on T has been that since my T level remains fairly
constant as I use a moderate and regular dose, I don't “rage” at
all. My irritability levels are no higher than they were when I was
completely empty of sex steroids, and are much lower than they were
under the three-gonad-circus levels I produced naturally before
gonadectomy.

What's
really interesting, though, is that my behavior has become a lot less
dominating and aggressive than it was before my hormonal transition.
I used to be very vigorously argumentative. As an academic who was
read as a woman, I had to be quite assertive in order to have
authority in a classroom or at a conference. It's part of our gender
culture that men interrupt women, assuming greater authority in
conversation, and engage in the phenomenon of “mansplaining”
(i.e., explaining to a woman something she already knows in a
patronizing manner). To avoid loss of social prestige as an
academic, I was therefore very assertive in conversation, so as not
to allow myself to be interrupted or to appear “weak” in the
presentation of my ideas to (male) students or colleagues.

After
some time on HRT, I found myself taken aback by how I was being
perceived. People had become more reserved around me, and somehow
more hesitant in conversation. I made a couple of female students
cry when critiquing their comments. My behavior had not changed at
all—but my social gender had. The level of dominance I'd asserted
for many years was now coming across, not as simple authority, but as
intimidating. I wonder if some people thought T had made me “mean,”
or that I was acting in the gender-stereotyped manner cissexism claims
to be characteristic of trans people. In any case, I had to
consciously modify my behavior. It took me a while to retrain myself
to be more restrained and gentle in my presentation. It was kind of
amusing to learn how much more intimidating the assertive comments of
a person who is 5'2” would be taken once he was understood as
male—but also sad proof of the greater authority granted men in our
society. Such is male privilege. . .

So:
my take on the idea that T biologically induces rage and dominance is
that it is pretty much bullpucky. Big fluctuations in the level of T
can cause irritability, as do big swings in the level of E and P, but
that's about it.

I
don't mean to come across as saying that none of the changes that we
associate with temperament and relate to sex hormones have any
biological basis. One that I can speak to is crying. For many
years, with my high hormone load being dominated by E and P, I cried a lot, and I hated it. The crying stopped when my gonads
were removed, and did not resume when I started taking T, to my great
relief. And I see that my friends on HRT with E cry much more
easily. The thing is, this does not
mean I don't get sad or frustrated any less often than I did in the
past, or that they used to be emotionally insensitive and now are
oversensitive. One of my trans women friends sees being able to cry when
upset as one of the greatest gifts of HRT, because people will
finally acknowledge the depth of her feelings. I am happy that I
don't tear up easily anymore because I have always enjoyed being treated as having
an emotional even keel. These relate clearly to gender roles, in
which being emotionally expressive is valued in women and devalued in men. Hormones
may affect how often we cry, but it's society that gives that great
meaning.

Consider
this: like crying, hiccups are also related to higher levels of
estrogen. I used to get the hiccups a lot; now I don't. However,
since hiccups are not burdened by any gender meanings in our society,
nobody else has noticed or gives a fig leaf how often I hiccup. Also
related to estrogen are more mobile bowels—people with high E suffer from
irritable bowel syndrome a lot more than people with low E. A less irritable bowel is another thing
I've enjoyed about my T-only hormonal balance that is clearly
biologically-induced, but given no social meaning in my transition.
The fact that I don't cry much anymore, however, has been remarked
upon a lot, and is treated as highly significant.

So,
the relationship between nature and nurture in producing “sex
difference” is complex. What is clear is that since humans are
such profoundly social beings, social forces shape even those things
that are usually thought of as “purely biological,” like the
effects of sex hormones. It's one of the things that makes
understanding humans fascinating.

About Me

I'm an academic and scaler of boundary walls, intersex by birth, female-reared, legally transitioned to male status, and pleased with my trajectory. Come journey with me! I blog about intersex issues at http://intersexroadshow.blogspot.com/, and about trans issues at http://trans-fusion.blogspot.com/.
If you are interested in contacting me or having me speak to your organization, please email intersexroadshow@gmail.com.

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For a guide on sex and gender terminology you can use and share, click here. You can find my critique of the concept of "passing" here. Click here for a discussion on the rights of intersex and trans kids. Here's where I explain that testosterone doesn't "work better" than estrogen. And my posts on TERFs--trans exclusionary radical feminists--can be found here and here.